Definitive Surgery after Neoadjuvant Chemotherapy for Locally Advanced Oral Cavity Cancers: Experience from a Tertiary Care Center

 

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Abstract

Background Oral cavity cancers require definitive surgical resection as the primary treatment, but with advanced T stage, complete resection with pathologically negative margins might be difficult to achieve. Induction chemotherapy helps achieve the balance between resection and morbidity in locally advanced technically unresectable tumors. The aim of this study was to analyze the impact of surgery in locally advanced, technically unresectable oral cavity cancers after neoadjuvant chemotherapy (NACT).

Materials and Methods A retrospective analysis of patients with borderline resectable, locally advanced oral cavity cancers who were given NACT between February 2017 and December 2021 was conducted. Data regarding clinical and pathological characteristics, NACT, surgery, adjuvant therapy, and recurrences was analyzed.

Results Of the 69 patients in the study, 69.6% had tongue cancer, rest were gingivobuccal complex cancers. All tumors were resected based on the post-NACT tumor volume and clear margins were achieved in 42% of cases. About 85.4% of the tongue cancers required a lesser resection than anticipated, thereby following the concept of organ and functional preservation post-NACT as proposed by Licitra et al. About 30.4% had ypT0 and 17.4% had ypN0. Recurrence and survival rates noted in our study were comparable to those reported in literature. Lymph node density of more than or equal to 0.07 was found in all recurrent cases.

Conclusions Induction chemotherapy offers a chance of achieving adequate surgical resection while reducing morbidity and improving functional outcomes for patients with technically unresectable oral cavity cancers. Nodal disease may not respond to chemotherapy as well as the primary tumor. There is a need for comprehensive evaluation of prognostic factors, which could help identify the patients who will most benefit with NACT.

Note

Interim analysis was presented at:

1. Oral presentation at Annual Research Day—2019, Christian Medical College, Vellore, India—awarded first place.

2. E-poster presented at Annual FHNO Conference, 2019 at Chennai, India.

Ethical Approval

This study has been approved by Institutional Review Board of Christian Medical College, Vellore; IRB No: 12662 [Retro].

Authors' Contributions

M.A., V.K., and A.J.T. conceptualized and designed the study. M.A., R.J. helped in data acquisition. V.K., R.K., A.S., and A.J. contributed to quality control of data and algorithms. M.A., V.K., R.J., R.K., A.S., and A.J. helped in data analysis and interpretation. M.A., V.K., and R.K. helped in statistical analysis. M.A. and V.K. prepared the manuscript. V.K. and A.J.T. edited the manuscript. A.J.T., A.S., and A.J. reviewed the manuscript.

Publication History

Article published online:
10 April 2023

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